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DiNapoli: SED Makes Progress on Implementation of Dignity for All Students Act
… requirements on the “ Responding to Incidents” sample form it made available during an August 2018 training and on …
https://www.osc.ny.gov/press/releases/2019/11/dinapoli-sed-makes-progress-implementation-dignity-all-students-actRFP#0010 – Financial Organization (Trustee) Services for Length of Service Award Programs
… available via the links below. The solicitation, and other information as it becomes available, is available … solicitation has been posted in Adobe Acrobat PDF format and may be opened with the free Acrobat reader, available …
https://www.osc.ny.gov/procurement/rfp0010Administration of the CityFHEPS Program for Department of Homeless Services Shelter Residents
… thereby assisting Department of Homeless Services shelter residents in securing permanent housing. The audit … were approved for CityFHEPS and subsequently exited the shelter into permanent housing. In one case, a client had to … are identified and receive Shopping Letters, and that shelter exits are recorded and reported accurately. DSS does …
https://www.osc.ny.gov/state-agencies/audits/2024/10/30/administration-cityfheps-program-department-homeless-services-shelter-residentsNew York Institute for Special Education – Compliance With the Reimbursable Cost Manual
… Objective To determine whether the costs reported by the New York … (CFRs) were reasonable, necessary, directly related to the special education program, and sufficiently documented … To determine whether the costs reported by the New York …
https://www.osc.ny.gov/state-agencies/audits/2024/12/18/new-york-institute-special-education-compliance-reimbursable-cost-manualAdministration of the CityFHEPS Program for Department of Social Services Homebase Clients
… the homelessness crisis. According to the Coalition for the Homeless, the court-appointed independent monitor of … providers. As a result, program applicants were exposed to apartment units with immediately hazardous violations despite … we found that DSS staff approved a client to move into an apartment with significant habitability issues, despite …
https://www.osc.ny.gov/state-agencies/audits/2026/01/07/administration-cityfheps-program-department-social-services-homebase-clientsMedicaid Program – Medicaid Payments for Early Refills of Prescription Drugs and Supplies
… amount has been used, or up to a 10-day supply of medication is remaining of the cumulative amount that has … apply). To prevent stockpiling and potential misuse of medication, DOH uses system controls known as edits to deny …
https://www.osc.ny.gov/state-agencies/audits/2026/03/20/medicaid-program-medicaid-payments-early-refills-prescription-drugs-and-suppliesUnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59 (Follow-Up)
… our audit report, UnitedHealthcare: Improper Payments for Medical Services Designated By Modifier Code 59 (Report … with UnitedHealthcare (United) to process and pay medical and surgical claims for services provided to Empire Plan members. United’s payments to medical providers are based, in part, on procedure codes …
https://www.osc.ny.gov/state-agencies/audits/2017/12/27/unitedhealthcare-improper-payments-medical-services-designated-modifier-code-59-followMedicaid Program – Managed Care Premium Payments for Recipients With Comprehensive Third-Party Insurance
… Health (Department) made Medicaid mainstream managed care premium payments on behalf of individuals who had … Medicaid pays managed care organizations (MCOs) a monthly premium for each enrolled Medicaid recipient, and the MCOs … paid about $1.28 billion in Medicaid managed care premium payments on behalf of enrollees who also had …
https://www.osc.ny.gov/state-agencies/audits/2018/06/13/medicaid-program-managed-care-premium-payments-recipients-comprehensive-third-partyUnitedHealthcare – Overpayments for Out-of-Network Anesthesia Services Provided at In-Network Ambulatory Surgery Centers
… To determine whether UnitedHealthcare overpaid for out-of-network anesthesia services provided at Ambulatory Surgery … Program (NYSHIP), administered by the State Department of Civil Service (Civil Service), provides health insurance … The Empire Plan provides its members with four types of health insurance coverage: medical/surgical, hospital, …
https://www.osc.ny.gov/state-agencies/audits/2018/08/13/unitedhealthcare-overpayments-out-network-anesthesia-services-provided-network-ambulatorySchool for Language and Communication Development – Compliance With the Reimbursable Cost Manual
… with disabilities who are between three and five years of age. SLCD is reimbursed for preschool special education … SLCD’s tuition reimbursement rates. Remind SLCD officials of the pertinent SED requirements that relate to the … clarification as needed. Other Related Audits/Reports of Interest Birch Family Services, Inc.: Compliance With the …
https://www.osc.ny.gov/state-agencies/audits/2018/04/16/school-language-and-communication-development-compliance-reimbursable-cost-manualLifeline Center for Child Development, Inc. – Compliance With the Reimbursable Cost Manual
… to children with disabilities who are between the ages of three and five years. During the 2014-15 school year, … served about 52 students. The New York City Department of Education (DoE) refers students to Lifeline and pays for … by SED. The DoE is reimbursed by SED for a portion of its payments to Lifeline. For the three fiscal years ended …
https://www.osc.ny.gov/state-agencies/audits/2017/10/12/lifeline-center-child-development-inc-compliance-reimbursable-cost-manualUnited HealthCare – Overpayments for Services Provided by Orthopedic Associates of Long Island
… Orthopedic Associates of Long Island, LLP waived Empire Plan members’ out-of-pocket costs, and if so, to quantify the … school district employees and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, covering a range of services from inpatient …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-orthopedic-associates-long-islandMedicaid Program – Improper Payments for Controlled Substances That Exceed Allowed Dispensing Limits
… pharmacies can dispense when prescriptions are ordered via telephone or fax, due to the inherent risk of drugs ordered … allowed by the Act. In one instance, a pharmacy filled two telephone orders for alprazolam (a drug used to treat … Each order was filled for a 30-day supply even though telephone orders for this drug are limited to a five-day …
https://www.osc.ny.gov/state-agencies/audits/2015/02/06/medicaid-program-improper-payments-controlled-substances-exceed-allowed-dispensing-limitsUnited HealthCare – Overpayments for Services Provided by Eastern Orange Ambulatory Surgery Center
… the $1,480 due from the member. Eastern Orange wrote off all charges in excess of United’s payment from the member’s …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-eastern-orange-ambulatory-surgery-centerPayments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)
… Background Our initial audit report, which was issued on August 13, 2013, determined that, for the period January 1, …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacy-followMedicaid Program – Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care
… Medicaid made improper fee-for-service claim payments for pharmacy services covered by recipients’ managed care plans. … provided to their enrollees. Prior to October 2011, pharmacy benefits were reimbursed through the fee-for-service … care coverage. However, beginning October 1, 2011, most pharmacy benefits were covered by managed care plans, and …
https://www.osc.ny.gov/state-agencies/audits/2015/01/05/medicaid-program-improper-fee-service-payments-pharmacy-services-covered-managed-careEducators for Children, Youth and Families, Inc. – Use of Contract Funds (Follow-Up)
… recommendations included in our initial audit report, Educators for Children, Youth and Families, Inc. - Use of … which was issued on August 20, 2010, examined whether Educators for Children, Youth and Families, Inc. (Educators) … Department/Office of Children and Family Services: Educators for Children, Youth and Families, Inc. - Use of …
https://www.osc.ny.gov/state-agencies/audits/2013/08/13/educators-children-youth-and-families-inc-use-contract-funds-followMedicaid Program – Improper Payments for Ancillary Services Provided During Hospital Inpatient Admissions
… Purpose To determine whether the Department of Health's eMedNY system processes Medicaid claims for … refer to health care services provided in the home, medical offices, clinics, and other freestanding sites. They … Department's Medicaid reimbursement policies. Some edits check various Department files to verify recipient …
https://www.osc.ny.gov/state-agencies/audits/2014/04/03/medicaid-program-improper-payments-ancillary-services-provided-during-hospital-inpatientMedicaid Program – Medicaid Payments for Pharmacy Claims: Joia Pharmacy and a Related Prescriber
… with applicable Medicaid laws and regulations as well as the rules and policies set forth by the Department of … of Medicaid’s payments to Joia were for patients who lived approximately one hour away (one way); and 134 of the …
https://www.osc.ny.gov/state-agencies/audits/2017/06/27/medicaid-program-medicaid-payments-pharmacy-claims-joia-pharmacy-and-related-prescriberOversight of Hotels and Motels Used for Homeless and Mixed-Use Temporary Residency
… the facility deficiencies we identified through our site visits, OTDA officials detailed organizational, legal, …
https://www.osc.ny.gov/state-agencies/audits/2017/06/27/oversight-hotels-and-motels-used-homeless-and-mixed-use-temporary-residency